Roche’s Avastin remains most requested drug in UK’s cancer drugs fund

Accounts for nearly a quarter of all applications

Almost a quarter of all applications to the UK's cancer drugs fund between April 2011 and March 2012 were for Roche's Avastin, according to figures released by the NHS' National Cancer Action Team (NCAT).

Of the 10,797 requests made during that period to the fund, which provides £200m a year for local health authorities to purchase cancer drugs that have not been recommended by the UK's National Institute for Health and Clinical Excellence (NICE), 24.8 per cent (about 2,677) were for Avastin (bevacizumab) in several types of cancer.

Merck KGaA's Erbitux (cetuximab) and Janssen's Zytiga (abiraterone) came second and third respectively, with 11.9 per cent (about 1,284) and 11.8 per cent (about 1,274) of total requests.

However, this looks set to change following NICE's recommendation for Zytiga in the treatment of advanced prostate cancer, meaning the drug is available for mainstream NHS use.

Completing the top five most requested drugs were Roche's MabThera (rituximab), which had 5.3 per cent of all requests (about 572) and GlaxoSmithKline's Tyverb (lapatinib), which had 5.2 per cent of all requests (about 561).

The ten most commonly used drugs accounted for 80 per cent of the total number of applications

Most requested drugs using cancer drugs fund

Drug

Percentage of cancer drug fund applications

1

Avastin (Roche - bevacizumab)

24.8

2

Erbitux (Merck KGaA - cetuximab)

11.9

3

Zytiga (Janssen - abiraterone)

11.8

4

MabThera (Roche - rituximab)

5.3

5

Tyverb (GSK - lapatinib)

5.2

6

Afinitor (Novartis - everolimus)

5

7

Nexavar (Bayer - sorafenib)

4.5

8

Levact (Astellas - bendamustine)

4.5

9

Faslodex (AstraZeneca - fulvestrant)

3.6

10

Halaven (Eisai - eribulin)

3.1

Elsewhere in its bulletin, the first since the launch of the cancer drugs fund in April, 2011, NCAT acknowledged concerns regarding regional variations in the number of applications made to the fund.

This was picked up by the UK Department of Health, which published a breakdown of applications by strategic health authority (SHA).

During April 2011 to May 2012, the SHA with the most funding requests was NHS West Midlands with 1,658, while the NHS North East had the fewest number of requests with 696.

“By publishing this data, patients can see how the Fund is being used in their area and across the country,” said care services minister Paul Burstow.

These regional concerns were also mentioned in the Rarer Cancers Foundation (RCF) report on the cancer drugs fund, which claimed that once population size has been adjusted for, NHS South East Coast had an approval rate over 50 per cent higher than that in NHS North West.

“The reasons for this require further exploration but suggest that significant variations in access existed prior to the cancer drugs fund,” said the report.

The RCF also highlighted the need to take action before the Fund is set to close in March 2014, three months a new value-based pricing drug reimbursement system is due to take effect in the UK.

“We estimate that the result of this change would be to deny over 16,000 cancer patients life-extending treatment every year. Over the course of the next Parliament (expected to be 2015-2020), this would mean that over 80,000 patients could be denied clinically effective cancer treatments,” the RCF said.

Recommendations suggested by the RCF to overcome such issues include a mechanism to enable treatments currently reimbursed through the Cancer Drugs Fund to be appraised as part of value-based pricing (VBP), with the discussions on how this would work in practice to begin by early 2013.

If such a process is not in place by early 2013, the Fund should be maintained as a transitional measure so as to ensure continuity of access, according to the RCF.

Such concerns follow comments from Roche in June, 2012, when the pharma company called for the Department of Health to quicken the process towards pricing negotiations or patients would miss out.

Since then, the DH and the Association of the British Pharmaceutical Industry (ABPI) have confirmed the drug pricing negotiations will begin next month.

As part of these negotiations, the possibility of using a new VBP assessment on drugs currently funded through the cancer drugs fund will be assessed as per RCF's recommendations.